Are statins and omega-3s incompatible?

French researcher, Dr. Michel de Lorgeril, has been in the forefront of thinking and research into nutritional issues, including the Mediterranean Diet, the French Paradox, and the role of fat intake in cardiovascular health. In a recent review entitled Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3?, he explores the question of whether statin drugs are, in effect, incompatible with omega-3 fatty acids.

Dr. Lorgeril makes several arguments:

1) Earlier studies, such as GISSI-Prevenzione, demonstrated reduction in cardiovascular events with omega-3 fatty acid supplementation, consistent with the biological and physiological benefits observed in animals, experimental preparations, and epidemiologic observations in free-living populations.

2) More recent studies (and meta-analyses) examining the effects of omega-3 fatty acids have failed to demonstrate cardiovascular benefit showing, at most, non-significant trends towards benefit.

He points out that the more recent studies were conducted post-GISSI and after agencies like the American Heart Association's advised people to consume more fish, which prompted broad increases in omega-3 intake. The populations studied therefore had increased intake of omega-3 fatty acids at the start of the studies, verified by higher levels of omega-3 RBC levels in participants.

In addition, he raises the provocative idea that the benefits of omega-3 fatty acids appear to be confined to those not taking statin agents, as suggested, for instance, in the Alpha Omega Trial. He speculates that the potential for statins to ablate the benefits of omega-3s (and vice versa) might be based on several phenomena:

--Statins increase arachidonic acid content of cell membranes, a potentially inflammatory omega-6 fatty acid that competes with omega-3 fatty acids. (Insulin provocation and greater linoleic acid/omega-6 oils do likewise.)
--Statins induce impaired mitochondrial function, while omega-3s improve mitochondrial function. (Impaired mitochondrial function is evidenced, for instance, by reduced coenzyme Q10 levels, with partial relief from muscle weakness and discomfort by supplementing coenzyme Q10.)
--Statins commonly provoke muscle weakness and discomfort which can, in turn, lead to reduced levels of physical activity and increased resistance to insulin. (Thus the recently reported increases in diabetes with statin drug use.)

Are the physiologic effects of omega-3 fatty acids, present and necessary for health, at odds with the non-physiologic effects of statin drugs?

I fear we don't have sufficient data to come to firm conclusions yet, but my perception is that the case against statins is building. Yes, they have benefits in specific subsets of people (none in others), but the notion that everybody needs a statin drug is, I believe, not only dead wrong, but may have effects that are distinctly negative. And I believe that the arguments in favor of omega-3 fatty acid supplementation, EPA and DHA (and perhaps DPA), make better sense.



Comments (4) -

  • Ellen Lewis

    6/18/2013 7:32:42 PM |

    thanks, this seems a sensible take on the issue.

  • Dolph

    6/30/2013 4:59:57 PM |

    This is a (too) far stretched conclusion pretty obviously. O3s still haven’t shown any consistent benefit alone, with a statin drug or without it, and cherry picking the studies that seem to look doesn’t help that fact either! The data is just inconclusive.

    A much more interesting blog article I hope to read in the future would be about niacin!
    Niacin has shown more than once to produce favourable outcomes alone and combined with resins. (CDP, FATS, etc.) On the other hand there can be no more doubt that it doesn’t add any benefit to statin therapy after the results of the two big clinical endpoint studies (AIM-HIGH and HPS2-THRIVE), that flush the cute little landmark studies (ARBITER, HATS, etc.) down the toilet where they belong.
    So what does that imply for the TYP-programm? A rhetorical question it should be, but I’m sure somebody will add some woo…

    - See more at: http://blog.trackyourplaque.com/2013/05/dha-the-crucial-omega-3.html#comments

  • Stephen in Jacksonville

    7/3/2013 10:15:53 PM |

    It is interesting that he should be doing this research into how statins react with Omega-3's. Statins may be one of the most widely prescribed drugs at this point, and I certainly think more research should be conducted on their long-term effects. I recently read about another study which looked at the effects of exercise and statins. Apparently, this drug actually works to counteract some of the benefits that are gained by getting regular exercise for people with cholesterol problems.

  • Brandon Barclow

    7/18/2013 6:07:47 PM |

    Stephen in Jacksonville.   There's no maybe to it.  The number 1 and number 2 selling drug in the world are statin drugs.  32 million Americans are currently taking statin medication.  The one thing that the 32 million have in common is:  THEY HATE TAKING THEIR MEDICATION.

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The ultimate “bioidentical” hormone

The ultimate “bioidentical” hormone

There has been a lot of debate over whether or not “bio-identical” hormones, i.e., hormones identical to the human form, are superior to non-human forms dispensed by the drug industry.

The FDA is currently taking steps to clamp down on availability of bioidentical hormones and their claims of superiority, despite a groundswell of grassroot support for them. The argument has pitted anti-aging practitioners and the public, as well as the likes of Oprah and Suzanne Somers, against Big Pharma and the FDA, the two forces trying to squash the bioidentical hormone movement.

Regardless of what heavy-handed approach the FDA takes, we already have access to hormones identical to the original human form. It requires no prescription and yields downstream hormones that the human body recognizes as human.

That "bioidentical" hormone is pregnenolone.

Pregnenolone is the first biochemical step in the conversion of dietary cholesterol (yes-cholesterol!) to numerous other hormones. Pregnenolone is the source of the hormones that lie at the center of the bioidentical hormone controversy: estrogens, progesterone, and testosterone. We therefore already have our own over-the-counter, non-prescription form of bioidentical hormones.

Supplemental pregnenolone increases estrogens (mildly), progesterone, and testosterone. Prenenonlone supplementation simply provide more of the basic substrate for hormone production. The increase in hormones is usually modest, not as vigorous as direct hormone replacement like, say, testosterone or progesterone topical creams. But pregnenolone can be useful when small to moderate increases are desired, such as for reduction of Lp(a). A theoretical downside is that pregnenonlone can also convert to cortisol, the adrenal gland hormone that regulates fluid and blood pressure. However, I've not seen any measurable increase in cortisol with low doses of pregnenonlone and limited data suggest that it does not. Pregnenolone also converts to the other adrenal gland hormone, DHEA; I call DHEA "the hormone of assertiveness," since some people who take too much pregnenolone (or direct DHEA) acquire excessive assertiveness.

The key to pregnenolone supplementation is to proceed gradually and begin with a small dose, e.g., 5 mg every morning. Hormonal assessment is best conducted periodically to assess the effects and to determine whether a dose adjustment is in order.

Comments (19) -

  • Jenny

    7/2/2009 12:46:09 PM |

    Dr. Davis,

    I have tried  "bioidentical" female hormones from a compounding pharmacy and ended up with sky high blood pressure and blood sugar. I do very well on the pharmaceutical yam-based estrogen. So I would caution people not to assume these hormones are benign.

    I also have supplemented pregnenolone for a while and had to stop as I also started to see bad results with blood pressure and a hint of masculinizing.

    So I would warn older women to be very careful with these hormones. The doses seem to be set very high and some of them may be optimized for males.

  • Nancy LC

    7/2/2009 4:36:31 PM |

    Dr. Davis, do you recommend any particular brand of pregnenelone?

  • billye

    7/2/2009 9:06:47 PM |

    Dr. Davis,

    Ordinarily I would have no interest in the ultimate " bioidentical" hormone" but, my daughter is going through her changes and is having a bad time with them.  Could pregnenelone be used to alleviate problematic symptoms? She is dead set against hormone therapy because she has a fear of  cancer.

  • Anonymous

    7/3/2009 3:04:08 AM |

    Bioidentical hormones have been a godsend for me... after "toughing out" a particularly long and difficult perimenopause I was in pretty dire straits.  I found a doctor who uses both mainstream Big Pharma hormones and bioidenticals in his ob/gyn practice, depending on the patient and their needs.  He is board certified, highly skilled, and compassionate.  After some trial and error and numerous blood tests, we arrived at compounded estrogen and progesterone as the best for me.  Gone are many horrible symptoms, so of course I would be very upset if the FDA were to "crack down" on "bioidenticals" in favor of manufactured Big Pharma products.

    That being said, if the FDA is so inclined... I will roll with it.  There are several prescription estrogen products, both oral and topical that could meet my needs.  They are for the most part manufactured from soy (as are most bioidenticals).  There are also some progesterone products manufactured by Big Pharma companies... and I am betting we can figure out how to get to the combination and dosage I require to feel good and normal.

    What won't I take?   Well Premarin and Prem-Pro for starters.  They're not bioidentical... in fact they are foreign to the human body.  Equilin,  derived from pregnant mares urine, or manufactured from soy, is not a requisite of the human body and IMO doesn't belong there. Give women a foreign hormone substance for years and wonder why the alarming results?  Hummm...

    As for pregnenolone, I don't think so, at least not for me.  At this late date, I doubt that my body would be efficient in utilizing it, or sending it down the correct pathway.  Why not just use the real things?

    madcook

  • Anonymous

    7/3/2009 3:42:55 AM |

    DHEA can cause substantial hair loss in men, it did suddenly and acutely in me.

  • pmpctek

    7/3/2009 4:42:09 AM |

    I'm no expert but it's my understanding that pregnenolone is the raw material for the production of DHEA, which is the raw material for the production of testosterone, estrogen, and progesterone.

    It's also my understanding that it's always best to try and supplement "bioidentical" hormones that are closest to the natural target hormone.

    If that's true and if pregnenolone is low and DHEA normal (say through supplementation) what's the point of taking pregnenolone at all?

  • Anonymous

    7/3/2009 2:15:38 PM |

    I've been on bioidentical hormones (progesterone) for 18 months and have had incredible success. I'm under the care of a MD who specializes in bioidentical hormones. Bioidenticals are safe and effective if the supplementation is medically supervised.

  • Anna

    7/3/2009 5:27:29 PM |

    At 47 yo, still cycling regularly but definitely perimenopausal the past few years.  New cycles start every 14-20 days (normal in every other way) if I don't use progesterone, but with progesterone, cycles are closer to normal length, every 21-28 days.  

    I've been using bioidentical OTC progesterone cream for a little over two years with very good results and no side effects that I can detect.  Just this week I switched to a higher prog dose via compounded Rx, as symptoms were returning/increasing the past couple months (especially midcycle extreme breast tenderness and increased lumpiness- negative ultrasound and mammograms though thermogram was suspicious, plus last exam indicated return of uterine fibroid - all suggestive of high estrogen/low progesterone imbalance).  

    A recent luteal phase test of estradiol showed it to be twice as high (549 pg/ml) as the upper end of the ref range, which explains the dramatically increased symptoms.  Guess those ovaries are screaming in protest during their decommissioning!  Progesterone levels were in the tank.  So was 8am cortisol level.  

    BTW, I've always avoided any supplemental phytoestrogens such as soy, "menopause" herbs, etc.  Numerous lood tests over the past 15 years have indicated no lack of estradiol (esp in recent years), but in fact, chronically low progesterone, despite regular cycles.  

    Along with years of undiagnosed hypothyroidism, I think low progesterone and a slightly shortened luteal phase were likely reasons why I had trouble conceiving 8-15 years ago (despite two infertility work-ups and "expert" review of my tests).  Wish I knew then what I know now (don't we all?)

    This backlash against biodidentical hormones, orchestrated by Wyett and other Big Pharma patent holders is very disturbing.  Like any other drug, the skill, experience, and knowledge of the doctor is crucial in prescribing them for the best effective treatment.  

    I've been cautious about self-treating with OTC hormones without some experienced guidance, including pregnenolone, because I wasn't sure it wouldn't convert to more estradiol instead of the progesterone and testosterone I needed.  But it took a long time to find an MD which the right experience.  Of course, she's not in my HMO-subscribed system so I have to pay out of pocket for office visits or compounded Rx, but it's worth it.  She writes the lab orders on a Rx form, which I take to the HMO lab, so insurance covers any of the lab tests they do.  Results are faxed to the ordering MD, even though she isn't in the system.

  • Jim, Guacamole Diet

    7/5/2009 3:41:40 AM |

    I guess I'm just an ignorant old Luddite, but I'm skeptical of all substances that don't come in natural foods. No prescription or OTC stuff for me if I can avoid it.

  • homertobias

    7/9/2009 3:39:50 PM |

    Anna,

    Late 40's are a rough time of life, kind of like being a 13 year old girl in reverse.  Ovaries are cranky as they rev up and as they rev down.  Next they start behaving like loose lightbulbs. They turn off for a month or three then they turn right back on.  It is hard to relie on hormone levels in that phase because things just keep changing.
    Late 40's usually screams progesterone deficiency.  First up to treat is usually vitex 500mg whole fruit daily.  Takes 3 months for full effect. Dirt cheap.  It works as a prolactin inhibiter and a progesterone booster.  Second is progest cream.  Third compounded progesterone or prometrium.  Route of prometrium varies with symptomatology.  Can't sleep?  Progesterone needs to be oral.  Still can't sleep?  Take it with food at bedtime to enhance absorbtion or up the dose.  Hung over in the morning?  Take it earlier.  Sleep not an issue but can't stand those early periods?  Use the progesterone vaginally at night.  Just shove it in as high as it will go.  The gelatin capsule dissolves and it goes straight to the uterus.

  • Elizabeth

    7/14/2009 9:58:46 PM |

    From my experience, bioidentical hormones really do work! After hearing so many people, like Susanne Somers and Oprah, talk about the
    benefits of hormone replacement
    therapy, I decided to give it a try. I looked around a lot, and I
    finally chose VieNue
    Bioidentical Testosterone Cream. All I have to say is, IT WORKS! My mood
    is so much better. I feel healthier. I have a healthy love life again - I
    used to always feel so "not into it." Now my husband and I are connecting
    again like we did years ago. Definitely give VieNue Bioidentical Testosterone
    Cream a try, you won't regret it. Here's the link vienue bioidentical testosterone cream

  • Anonymous

    7/26/2009 7:09:24 PM |

    You need to do a lot of reserach before starting hormone therapy... You should always have your hormones tested first! Saliva test is the best way to test your hormones levels. Also you need to use a compounding pharmacy that you can trust and a good doctor. This website helped to show why to choice bioidentcal hormones and you can even find a doctor in your area: http://www.bodylogicmd.com/research/safety-of-bioidentical-hormones

  • Amir

    8/21/2009 1:27:30 AM |

    I have been researching the bioidentical hormone therapy topic for a while and would like to see what people's opinions on the health benefits of bioidentical hormones like the reduction of breast cancer as explained in this article,

    http://bodylogicmd.com/hormone-articles/review-of-hormones-and-breast-cancer-can-we-use-them-in-ways-that-could-reduce-the-risk

  • Gloria Ives

    8/24/2009 4:01:45 AM |

    Can you address the cardiovascular risks associated with bioidentical supplementation as compared to typical pharmaceutical hrt?

  • Bioidentical Hormones UK

    9/24/2009 7:21:21 PM |

    Bioidentical hormones are products that are chemically identical to what's made in a woman's body.
    Some are approved as medications; others are supplements. Learn more about it from professionals in the field.

  • Anonymous

    9/25/2009 2:36:53 AM |

    Why not simply increase dietary cholesterol?

  • Lance Chambers

    3/1/2010 1:51:02 AM |

    I have watched the video and it's sad that corporate pharmaceutical industries have to chemically alter a natural substance in order to get patent for synthetic medicine or synthetic hormones but I think synthetic hormone should not have been approved for human use in the first place. It must have helped many people but in the long run it did more harm than good.

  • Lance Chambers

    3/1/2010 2:02:38 AM |

    Bioidentical hormones refer to hormones that are identical to the chemical structure of the hormones produced by a woman’s body therefore it is better and safer than synthetic hormones. Understanding your symptoms will also help you prepare for it and modification of lifestyle issues like healthy diet of organic foods to resist minor signs, light exercise to improve blood circulation level can help regulate the symptoms of hormone imbalance. Compounded bio-identical hormones are pills, creams, gels, suppositories, injectables, sublingual drops or lozenges that are prescribed by health care providers who tailor the dose to a woman’s individual symptoms and concerns.

  • buy jeans

    11/2/2010 8:16:26 PM |

    Pregnenolone is the first biochemical step in the conversion of dietary cholesterol (yes-cholesterol!) to numerous other hormones. Pregnenolone is the source of the hormones that lie at the center of the bioidentical hormone controversy: estrogens, progesterone, and testosterone. We therefore already have our own over-the-counter, non-prescription form of bioidentical hormones.

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